Cholecystocolic Fistula: A Diagnostic Dilemma.

Cholecystocolic fistula is a rare biliary-enteric fistula with a variable clinical presentation. Despite modern diagnostic tools a high degree of suspicion is required to diagnose it preoperatively1,2. Biliary-enteric fistulae have been found in 0.9% of patients undergoing biliary tract surgery. The most common site of communication of the fistula is a cholecystoduodenal (70%), followed by cholecystocolic (10-20%), and the least common is the cholecystogastric fistula accounting for the remainder of the cases. Even a case of choledochocolonic fistula through a cystic duct remnant has been reported3. These fistulae are treated by open as well as laparoscopic surgery with no difference in intraoperative and postoperative complications. We report a case of obstructive jaundice, which was relieved by itself and was investigated with abdominal ultrasonography and routine investigations but none of these gave us any clue to the presence of the fistula which was discovered incidentally during an open surgery and was appropriately treated.

Spectrum of malignancies in Jaipur region (2004‑2008).

CONTEXT: Cancer data from Rajasthan is limited. Only three studies, one from Western Rajasthan, and the other two from Eastern Rajasthan have been published previously. AIMS: To find out the spectrum of malignant neoplasms in Jaipur region by studying the proportion and site wise distribution of malignancy cases reported at five major hospitals and pathology centers in Jaipur region. SETTINGS AND DESIGN: A retrospective analysis of histopathology records of 5 years (2004-2008) was done. Approximately 200,000 histopathology and cytology reports were analyzed and 34,486 new cancer cases were identified. STATISTICAL ANALYSIS USED: Percentages and proportions. RESULTS: A total of 34,486 new cases of cancers were recorded in five years. There were 58.58% (20202) males and 41.42% (14284) females, with the male to female ratio being 1.41:1. Organ wise, Lung (13.25%), Larynx (5.35%), Oropharynx (5.09%), Brain (4.84%), Tongue (4.62%) and Prostate (4%) were the most common sites involved in males, whereas Breast (25.6%), Cervix (10.26%), Ovary (5.4%), Brain (3.68%), Esophagus (3.4%), Lung (3.01%) and Gall Bladder (2.35%) were common sites for malignancies in females. CONCLUSIONS: Significant findings were, a higher frequency of tobacco related cancers i.e., Lung cancer and Head and neck cancer in males, and screening detectable cancers (Breast and Cervix) in females. A higher frequency of Lung cancer in females was also noted as compared to previous studies. An unusually high frequency of Gall Bladder Cancers especially among the female population in this region is also a cause of concern. Our data was compared with the national data.

Distribution of malignant neoplasms reported at different pathology centers and hospitals in Jaipur, Rajasthan.

Background: Cancer data from Rajasthan are limited. Only two studies, one from Western Rajasthan, and the other from Eastern Rajasthan have been published by Sharma et al. in 1992 and 1996. Aims: To put the cancer profile from this region in proper perspective, we conducted the present study on the patterns of various malignancies in Jaipur region, i.e., Eastern Rajasthan. Setting and Design and Material and Methods: The study spans over one and half decade (1990-2004) and is based on a retrospective six-year sample analysis of approximately 200,000 histopathological and cytological reports for the years 1990, 1991, 1996, 1999, 2001 and 2004. Results: A total of 21,868 cancers were recorded in the six sample years. There were 59.11% (12,926) males and 40.89% (8942) females, with the male to female ratio being 1.45:1. Organ wise, lung (8.45%), prostate (7.12%), brain (6.04%), urinary bladder (5.31%), esophagus (4.67%) and tongue (4.60%) are most common sites involved in males with regard to frequency, whereas breast (20.44%), cervix (14.99%), ovary (4.35%), brain (3.80%), esophagus (3.67%), uterus (3.01%) and rectum (2.80%) are common sites for malignancies in females. Conclusions: Significant findings were a higher frequency of cancers of the prostate, urinary bladder, and brain in males along with gall bladder cancers in females. Our figures have been compared with the national data.

Cancer profile in eastern Rajasthan.

A study to determine the pattern of various malignancies in Eastern Rajasthan was conducted for the year 1990 by Cancer Registry, S.M.S. Medical College, Jaipur. This is the first study of its kind from this region where an effort has been made to put the cancer profile in East Rajasthan in perspective. A total of 2509 histologically proven cancer cases were recorded from the various government and private hospitals in this region. There were 1443 males and 1066 females. Maximum number of cases were seen in the 6th and 5th decade. Genital tract cancer (21%) formed the largest overall group of cancers. When combined with the urinary system (7.6%)--the uro-genital tract cancers (28.7%) formed almost one-third of all cancers in this region. Cancer of the prostate (11.40%) and urinary bladder (9.1%) in males recorded the highest incidence in the country. Cancer of the female breast (19.4%) surpassed cancer cervix (18.2%). The frequency of penile, testicular, bone, skin, anorectal cancers and lymphoma was on the higher side. Whereas the incidence of stomach, oesophagus and lung cancer was on the lower side. An urgent need is felt to study the various aetiological factors responsible for these significant variations in Eastern Rajasthan.

Cancer profile in western Rajasthan.

A retrospective study of malignancy was conducted in the arid region of Western Rajasthan over a period of five years (1984 to 1988) to determine the frequencies of various malignancies. This was the region where India's first nuclear explosion took place in 1974. During this period 2662 new cancer cases were recorded. In males, Oropharyngeal and Hypopharyngeal malignancies topped the list. Males had an overall higher incidence than females (1.28:1). Most of the cases were between 31 years and 60 years with male peak at 60 years and female at 50 years. In females, cancer of the cervix formed the largest group followed by Breast cancer. A comparatively high rate of skin, urinary bladder, bone malignancy, lymphoma and leukaemia was observed in this region. Limited investigational facilities, lack of trained personnel, tough working condition, extremes of temperature, long distances in the desert region, with associated poverty, illiteracy and ignorance were some of the factors responsible for majority of the patients presenting in advanced stages.

Visual evoked response in macular diseases.

Visual evoked responses (VER) were recorded in 10 patients with unilateral maculopathy. VER latency and amplitude were compared between the affected and unaffected eyes. Evaluation of results reveals that in macular disease with fluid accumulation (Central Serous Retinopathy and Traumatic Macular Oedema) the VER showed amplitude reduction depending on reduced visual acuity with no significant change in latency, whereas, in disease with degeneration of retinal layers, (Degenerative Maculopathy) latency was markedly increased signifying associated conduction defect.